Acceptance and Commitment Therapy as an Alternative to Exposure:

1
Acceptance and Commitment Therapy as an
Alternative to Exposure A Pilot Study in the
Treatment of Veterans Diagnosed with
PTSD Katharine C. Sears, Ph.D.1,2 Varvara
Mazina, B.A.1,2 Amy Wagner, Ph.D.3 Robyn D.
Walser, Ph.D.1 1VA Palo Alto Health Care System
National Center for PTSD 2Stanford University
School of Medicine 3Portland VA Medical Center
RESULTS
BACKGROUND
CONCLUSIONS

• Aggregate Analyses (n9)
• Preliminary results showed a significant
  decrease in average PTSD scores from pre- to
  post-treatment (mean ? -6.8, SD 8.6, p lt .05)
  and a clinically significant but not
  statistically significant decrease from
  pre-treatment to 3 month follow-up (mean ?
  -12.2, SD 17.7, p 0.15).
• Valued living increased significantly from pre-
  to post- (mean ? 1.3, SD 1.4, p lt .05) but
  not between pre- and follow-up (mean ? 2.0, SD
  2.2, p .08).
• Participants also reported non-significant
  improvements in several quality of life domains
  (WHOQOL-BREF) social relationships,
  psychological health, and physical health.
• Treatment satisfaction was high (means between
  8.67-9.17 on a 10-point scale) at post-treatment
  and 3 month follow-up.
• There was a non-significant change in Veterans'
  willingness to engage in exposure treatments
  after completing ACT.
• There was a significant increase in patients
  self-reported acceptance from pre- to
  mid-treatment (mean ? 5.8, SD 6.2, p lt .05)
  and from pre- to follow-up (mean? 11.3, SD
  9.7, p lt.05).
• Change in AAQ-2 scores from pre- to follow-up was
  significantly correlated with change in PCL-C
  scores over the same period.
• There was a non-significant downward trend in
  thought suppression from pre- to post-treatment
  and from pre- to follow-up.
• Individual-Level Data

• Pilot data indicate that ACT may lead to
  decreased PTSD symptoms and more values-based
  living for Veterans with PTSD.
• Veterans had realistic pre-treatment expectancies
  about ACT, and came to endorse it as a highly
  credible treatment for PTSD by post-treatment and
  follow-up.
• Correlation data show an association between
  changes in acceptance and PTSD symptom severity
  in this small sample, providing some support for
  ACT mechanisms of change.
• There is no evidence from this sample that
  completing a 12-session ACT protocol is
  associated with enhanced willingness to engaged
  in exposure-based treatments.
• Acceptance scores showed a familiar trend in ACT
  research of continuing to improve after treatment
  ends.
• Many Veterans want psychotherapy but are
  unwilling or unready to undergo trauma-focused
  treatment. The majority of Veterans with PTSD
  who refuse exposure receive treatments of unknown
  efficacy. ACT may be a viable alternative to
  exposure-based therapies in VA.

• There is a need to provide alternative
  therapies to the evidence-based standards for the
  treatment of PTSD.
• Drop-out rates and refusal rates for
  exposure-based therapies, the main
  empirically-based intervention for PTSD, range
  from 40-50 (Schnurr et al., 2007 van Minnen,
  Arntz, Keijsers, 2002).
• With its emphasis on acceptance and valued living
  in the present moment, Acceptance and Commitment
  Threapy (ACT) may be an effective alternative.
• In this ongoing multi-site VA pilot study, ACT
  was offered to Veterans diagnosed with PTSD who
  had already declined or dropped out of
  exposure-based treatment(s).

OBJECTIVES

• Aim 1 To determine the effectiveness of ACT to
  reduce PTSD symptoms
• Aim 2 To investigate how ACT processes
  (acceptance) area associated with reductions in
  PTSD symptoms
• Aim 3 To explore whether increased in
  acceptance is associated with an increased
  willingness to try exposure-based treatment(s).

LIMITATIONS FUTURE DIRECTIONS
METHODS

• This small pilot study is underpowered to draw
  any firm conclusions. More data is needed to
  confirm the validity of these findings.
• Future ACT research should include the efficacy
  of ACT in Veterans with traumatic brain injury
  (TBI).
• Future research should further investigate
  barriers to exposure-based treatments, and
  whether ACT may increase willingness to engage
  these options.

• Participants were recruited through VA PCT
  clinics in Livermore, CA, San Jose, CA, and
  Portland, OR.
• Only Veterans who had previously refused or
  dropped out of exposure-based treatment (before
  the 6th session) were eligible to enroll.
• Nine male Veterans (mean age 52.6, 50 Caucasian)
  completed a 12-week ACT protocol and answered a
  series of questionnaires at pre-, post-, and
  3-month follow up.
• Measures
• PTSD Checklist (PCL-C)
• Acceptance and Action Questionnaire (AAQ-2)
• 4-Item Values Questionnaire (developed for this
  study)
• White Bear Suppression Inventory (WBSI)
• Treatment Credibility/Expectancy Questionnaire
  (CEQ)
• World Health Organization Quality of Life Scale
  (WHOQOL)

References
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Pt. 1 TBI patient lost to f/u Pt. 4
dropout Pt. 8 treatment interruption Pt. 10
treatment not yet complete Pt. 3 TBI patient
Acknowledgements Poster production by the
National Center for PTSD Dissemination and
Training Division